Preventive Services Covered Without Cost-Sharing

What is new?

Many recommended HIV/AIDS, viral hepatitis, STD, and TB preventive services are available without cost-sharing to individuals with new private health plans, Medicaid expansion plans, or Medicare.

Most health plans (including Medicaid expansion plans) must cover a set of prevention services—like immunizations and screening tests—at no cost to the beneficiary, as long as the services are delivered by a doctor or other provider in the plan’s network. Visit Preventive health services | HealthCare.govExternal for additional information.

The preventive services covered without cost-sharing those that are recommended by the following sources:

Doctor talking to 2 patients seated in chairs

Private plans that existed on March 23, 2010 are considered “grandfathered” and are exempt from this requirement. However, as grandfathered plans make certain major changes (such as eliminating benefits or making sizable changes to cost-sharing or employer contributions), they lose their “grandfathered” status and must begin to cover these preventive services as all other non-grandfathered health insurance plans are required to do. 1

Medicare-covered preventive services that have a Grade “A” or “B” recommendation by the USPSTF are covered without cost-sharing for beneficiaries when delivered by a doctor or other health care provider who accepts Medicare assignment. 2

States have the opportunity to cover specified preventive services at no cost to standard Medicaid adult enrollees in exchange for an increase in federal matching payments. 3

What are the implications?

More at-risk individuals will have coverage, without cost-sharing, for many HIV/AIDS, viral hepatitis, STD, and TB preventive services.

How might health departments respond?

1) Increase awareness of the HIV/AIDS, viral hepatitis, STD, and TB preventive services available without cost-sharing.

Be familiar with the preventive services relevant to your program.

Disseminate the list of preventive services to the general public, health care providers, and program collaborators.

2) Promote utilization of clinical preventive services.

Encourage individuals and families to take full advantage of their preventive service benefits, where applicable.

Communicate to providers the importance of offering these preventive services to their patients.

Use morbidity statistics to target service delivery interventions to populations disproportionately burdened by disease.

  • NCHHSTP’s ATLAS – An interactive platform for accessing data collected by CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP)
Page last reviewed: March 21, 2018